Wiki 93005 payable with modifier?

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minoweka

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I have an encounter coded as follows:

99214-25 Paid
69210-AG Paid
93005 Paid/recouped.

Payer is MediCal(California Medicaid). They paid 93005 and then recouped to "bundled".

Is MediCal interpretting the 93005 included in the E&M?

Is there a modifier to append to 93005 to have it paid as separately identifiable?

Modifier -59 perhaps.

Thank you

Dorothy Poverelli CPC
 
I notice you're using modifier AG and billing an OV, so I assume this is for the physician? I ask because the EKG codes are split into a global, professional, and technical component. Instead of using 26 and TC, you use the code that represents whatever you're billing for. 93005 represents the technical portion, so that could be a reason it's being denied. Is someone else billing 93010? The only reason you would bill 93005 for the physician is if they own the equipment and are letting someone else use it. Also, it may be included in your surgery code. Usually any type of monitoring is not separately reportable by the physician performing the procedure. Hope this helps! :)
 
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